So What Exactly Is Early Menopause (And Am I In It)?

Meno 101 - January 13, 2022

By Dr. Ekta Kapoor 5-Minute Read

Dr. Ekta Kapoor is an endocrinologist at Mayo Clinic and a specialist in menopause and women’s sexual health. Her mission is to inform and empower women of every age to learn and prepare for menopause as early as they can.

So first things first, how do you define early menopause?

Dr. Kapoor: "Most women attain menopause between the ages of 46 to 55 years, with the average age being 51 years. If a woman becomes menopausal prior to the age of 40, it is known as premature menopause. Menopause between the ages of 40 to 45 is known as early menopause. In addition to having more severe symptoms of menopause, women going through premature menopause often have long-term adverse health consequences due to the lack of the female hormones, predominantly estrogen."

What are the reasons you can enter menopause early?

"There are several reasons for premature menopause. This could be a result of medical treatments, including surgery, chemotherapy, or radiation. For example, menopause results when a woman has both her ovaries removed surgically. This could be done to treat ovarian cancer, or to prevent breast and ovarian cancer, in women who are at high risk, usually in the setting of a predisposing genetic mutation. The ovaries are sometimes removed to manage benign conditions like endometriosis. However, such a decision should be considered very carefully, and the ovaries should be removed only if medical treatments fail to provide adequate symptom relief. Whenever possible, at least one ovary should be preserved, to avoid the consequences of lack of estrogen in a young woman.

"There are several reasons for premature menopause. This could be a result of medical treatments, including surgery, chemotherapy, or radiation."

Because there is a sudden decline in the hormones with removal of both ovaries, such women often experience very dramatic and abrupt symptoms of menopause, including hot flashes, night sweats, sleeping difficulties, and mood problems. Women who have a hysterectomy (removal of the uterus) but retain their ovaries are not considered to be in menopause, even though their periods stop. Therefore, lack of menstrual periods is not synonymous with menopause. Menopause is characterized by lack of fertility and lack of female reproductive hormones, most importantly estrogen.

Women who receive chemotherapy for treatment of cancer often experience damage to their ovaries, which may result in premature menopause. Women who are older than the age of 40 are more likely to experience ovarian failure from chemotherapy. Radiation therapy is another method used to treat several cancers. It is often used in combination with chemotherapy. In women who receive radiation to the pelvic area, damage to the ovaries can occur, leading to menopause. In case of low-dose radiation therapy use, ovarian damage can be temporary.

For some women who experience premature menopause, there is no obvious cause like surgery, radiation or chemotherapy. It may be related to certain genetic mutations, or autoimmune damage to the ovaries. Such women experience irregular periods, followed by complete cessation of their periods, infertility, and symptoms of menopause including hot flashes and night sweats. Their ovarian hormone levels are very low, and the ovaries have very few eggs when visualized on ultrasonography."

Are the symptoms the same?

"Premature menopause results in all the symptoms associated with natural menopause, although they are often more frequent and more severe, particularly in patients who have their ovaries removed, or those who receive chemotherapy or radiation. These symptoms typically include hot flashes, night sweats, sleeping difficulties, mood problems, cognitive complaints, sexual complaints including vaginal dryness and pain with intimacy. All these symptoms can have a significant impact on the quality of life of a woman.

"Premature menopause results in all the symptoms associated with natural menopause, although they are often more frequent and more severe."

In addition to the immediate consequences of premature menopause which include the symptoms detailed above, there can be significant long-term health effects of premature menopause. These include adverse effects on the health of a woman’s heart and her bones. She has a higher risk for heart disease and osteoporosis. Women with premature menopause are also at a greater risk for dementia, diabetes, high cholesterol, obesity, depression, and anxiety.

Premature menopause can have a significant impact on a woman's emotional health due to several reasons. First, for women desirous of having children, loss of fertility due to premature menopause can be a source of significant distress. Second, changes in the physical appearance that follow menopause, including weight gain, 'belly fat,' dry skin, and thinning of hair can be a source of frustration as well. The changes in sexual function in a young woman can significantly impact her self-esteem and emotional well-being."

What treatment do you suggest for women entering early menopause?

"Women with premature menopause should receive care from an expert who specializes in this area. The goals of treatment are to provide adequate medical treatment, which includes estrogen therapy for appropriate patients. Some women also need to be on testosterone therapy. However, all patients with premature menopause are not candidates for estrogen therapy. For example, women with a previous history of an estrogen sensitive cancer like cancer of the breast, or cancer of the uterus, should not receive estrogen therapy. In the absence of a reason to avoid estrogen therapy, women with premature menopause should be treated with estrogen until the average age of menopause, in order to treat their symptoms, but more importantly, to prevent the long-term consequences of premature menopause. These women also often require diligent counseling and support to improve their emotional well-being."